Welcome to the Jungle

Being a float nurse is probably one of the most interesting positions in the hospital....after all, you get to see and do a bit of almost everything: OB, ER, med/surg, even critical care. Here's how one 'floater' stopped worrying and learned to love the The Unit.

I've been out of acute care for many years now, but I'll never forget the experience of being a float nurse. It was the best of all possible worlds: I was cross-trained to all the different nursing departments instead of remaing stuck in Med/Surg, which even then was a thankless, backbreaking job. I got to learn how to 'catch' babies and take care of sick neonates; saw some grisly traumas in the emergency room; worked with respiratory therapy and served as the IV nurse.

But it was critical care which both fascinated---and intimidated---me the most. When I first cross-trained to The Unit, as we called it, I was expected to be nothing more than a glorified unit secretary, answering the phone, inputting physician orders, and assisting the "real" CCU nurses with turns and minor tasks like vital sign monitoring and perhaps the occasional discharge to the floors. But as I found myself floating to The Unit more and more frequently, the more I was accepted by the nurses there, and the more often I was permitted to participate in patient care.

One evening, I was actually given a patient of my own. She had been admitted with a blood glucose of 800 and was on an insulin drip, which required frequent adjustments per standing orders. It was fascinating to watch her progress from an almost coma-like state to conscious and confused, then to alert and oriented in the course of the 12-hour shift. Now, how rewarding is that?? To know that my interventions had saved a life, even though I was working under established protocols, was one of the most incredible feelings I'd ever had as a nurse.......and after that night, I was hooked.

I began to request shifts in The Unit whenever they were short-staffed, which was often. Even OB, which was my first love, took a backseat to all the excitement I found in critical care: the DKAs, the cardiac drips, the enormous gaping wounds, the sepsis. Ventilators were scary, so I rarely took those patients, but I was willing and eager to tackle other challenges, such as the patients on pressors. It was amazing to see what happened when the drips were titrated up or down; I'd start out with an unresponsive, grey-faced patient with a blood pressure of 40/20 and see him pink up and become alert within minutes as his pressure climbed back to normal levels.

There were also patients who stayed in The Unit too long and began to experience "ICU psychosis". I remember in particular a woman who weighed somewhere in the neighborhood of 450 lbs. and whose surgical wound had dehisced to the point where she had an eight-inch gap between the edges of the wound, which stretched from her umbilicus to her pubic bone. She'd been in The Unit for weeks, and then one night she pulled out her central line and her Foley and began to scream hysterically. She thought we were demons, and fought us with surprising strength as we tried to cover the CVC insertion site and get her into four-points.

If there is anything more physically exhausting than wrestling with a morbidly obese patient in the throes of a psychotic episode, I'm not sure what it is. I was still tired and sore the next time I was sent to The Unit a couple of nights later. Sad to say, the aforementioned patient had gone septic and was in the process of actively dying, so she was placed on comfort care and passed away early the following morning as we were giving report.

Then, there were the tragedies like "Bob", a middle-aged husband and father who had been brought in for complaints of chest pain. I was on Med/Surg admitting him after the ER had determined he was appropriate to be out on the floor with telemetry. What none of us knew was that he had the same congenital heart condition that had killed his father at age 46 and his older brother at age 38. This gentleman had just turned 40. As I helped him get settled in bed, his color began to change from pink and freckled, to pale, to grey.

I called The Unit at pale; they arrived at grey, and by the time we got him down to The Unit he was purple and beginning to mottle. At that point I became his nurse and stayed throughout the code.....and what haunts me to this day was the look of terror in his eyes as he clutched at my hand and begged me not to let him die. But the battle was over before it had begun, and we all knew it, though we coded him for what seemed like a long time. His wife and two young daughters were in the waiting room as we worked on him, and I'll never forget hearing her scream when the doctor went out there to give her the bad news.

That was the awful part of working in The Unit. But critical care had become my passion, and that's the only regret I have about leaving the hospital---I still miss the adrenaline rush of trying to save a patient who's crashing, the rewards of seeing someone walk out of The Unit after barely surviving an MI, and the camaraderie between nurses and doctors who have borne the battle together.

Wow. This makes me so comfortable about wanting to pursue a career on "The Unit". Thanks for sharing your experiences.

May 11, '13

Then there are the 'super sick': 3 or 4 stacks of pumps (yes, stacks), vent., CVVH, IABP, ECMO, heating blanket, perhaps with an open chest (yes, open) with a retractor in there because the lungs are too swolen with fluid overload to close 'em up after open heart surgery, as well as being paralyzed and sedated. NO TURNING. Two nurses (or more) on this one. One is the 'mechanic' keeping up with the machines, hanging blood, swapping out IV bags - the other doing the assessments, talking to the docs, family. So much equipment in the room that you have to remind yourself that indeed, there IS a patient in that bed somewhere. Even if you're in there only one or two shifts of their long stay, and they have no knowledge of the hours you sweated in labor to care for them, there is a definite feeling of pride and accomplishment over your part of their recovery as you see them sitting in the chair eating their breakfast a month later.

May 11, '13

The days on the unit... I worked Trauma, neurosurgical and general surgery ICU. Jamming 10units of PRBC's, FFPn ventric drains, bolts, floating SWAN GANZ catheters... It's nothing like a fresh trauma and doing bed side surgeries. OSCILLATORS (jet ventilators)after you hit the HIGH PEEP pressures up to 20 and if you disconnect, LAWD!!!

The teamwork is nothing like it. We're a lil cliquish but it's because we all seen life and death with each other and the new person has to prove themselves to feel comfortable with a patient on the brink of death.

May 11, '13

I have loved the unit the moment I walked in. Trauma OMG, love the team work, love helping the pt overcome the most horrific injuries or hold someone's hand so they don't die alone, holding families tight as they see the effects for the first time.. I don't see myself leave for a long time, as much as I dislike some things, I am there for a reason.

OP, thanks, you did a beautiful job writing this

May 11, '13

I have really been missing The Unit lately. I started fly career floating and ended up there a few months later and continued on for 4 and a half years. I left due to family commitments. I recently was doing inservicing in a major hospital over here and was on The U it and I wanted to just jump in. The sound of the monitor was SOOTHING to me.

I'll never forget many of my patients. But there was the one end stage breast CA on HD patient who went into flash pulmonary edema who grabbed my hand and said " I'm scared, Gineen, please don't let me die"

She got intubated but did not die in her course on the unit. About a year later I googled her and found her obituary. In the obituary they actually thanked the nurses of our hospital.

I remember a young cop who came in on the brink of death in septic shock. I was his primary night nurse, requested by his family when I was on shift. I'll never forget all the ups and downs we had with him. He made it with the loss of a foot and almost a hand. It turns out my ex sil's husband knows him and says he's doing well to this day, still working on the force although behind a desk

I miss like heck being a part of a great team and making such a difference in patients and families lives.

Ahhhhhh.

May 11, '13

As much as I love my psych patients and am actually looking forward to trying LTC, I'm so fearful that I'll never have this experience because of the career choices I've already made. There's a big part of me that would love to do ER...but I'm so scared that I'll never be strong enough or get the chance.

May 11, '13

I had such fear the first time I stepped on the unit. I never, and I mean NEVER, wanted to work anything with "really sick" patients. I thought my true love was postpartum. I am passionate about breast feeding and love to teach so I figured new moms were a great match for me. I never got the opportunity to even see if postpartum was a match for me. I graduated and went straight to the unit and have been in love ever since. I love to walk in to a room with every drip imaginable, ventilator, IABP, lines and tubes everywhere, a nice wound just for good measure, and a family and/or patient who wants to be educated about all that is going on. Even better is when the primary doc is a realist, too. I love to help patients heal. On the flip side, I also love to help the patient and family through the journey to death if that is the inevitable result. It is truly a privilege to be allowed to help during such stressful and intimate moments in someone's life or death.

May 11, '13

Aw viva . You brought back so many memories I had when working in acute care. Sometimes I miss working on the "unit". I recently started in ob and love it !!!!

May 12, '13

my friends who tried LTC completely despised it. I mean to each it's own but your a compassionate person say know.

I had such fear the first time I stepped on the unit. I never, and I mean NEVER, wanted to work anything with "really sick" patients. I thought my true love was postpartum. I am passionate about breast feeding and love to teach so I figured new moms were a great match for me. I never got the opportunity to even see if postpartum was a match for me. I graduated and went straight to the unit and have been in love ever since. I love to walk in to a room with every drip imaginable, ventilator, IABP, lines and tubes everywhere, a nice wound just for good measure, and a family and/or patient who wants to be educated about all that is going on. Even better is when the primary doc is a realist, too. I love to help patients heal. On the flip side, I also love to help the patient and family through the journey to death if that is the inevitable result. It is truly a privilege to be allowed to help during such stressful and intimate moments in someone's life or death.

I went into nursing school with the only plans of coming out and being a L&D nurse. Such a surprise to myself when I became an ICU nurse and loved it.

May 12, '13

Welcome to the Jungle is so right. I worked ICU, and, one day, an unstable patient arrived on our unit from the ER. Suddenly he started spewing blood from his mouth. Bright red blood, heavy clots: The man was exsanguinating from esophogeal varices.

Blood was all over the floor (we were slipping in it) and the Doctor inserted a Blakemore tube to tamponade the varices. We then did gastric lavage with ice cold water. The man survived for a few more days, long enough for his family to say goodbye.

Then there was the girl (young) who was stabbed by another girl over a mutual boyfriend. She ended up in the pulmonary ICU with ARDS. She was intubated, on PEEP, constantly monitored. She had massive infections because of the stabbing. The Respiratory Therapists at this medical center were fantastic.

The girl who was stabbed spent weeks in the pulmonary ICU and was finally deemed healthy enough to go home. That was a beautiful day.

May 12, '13

amazing. I am going to start my path on becoming an RN in sep. but didnt kno what field to take. you just described exactly what i want to do. we need more nurses like you,and i can only hope . Hats off.